[lucas_membrane]

I'm not an insider to the medical care industry, but I have plenty of friends and family who have worked there, and that is what I've heard from them over many years. Certainly, there is a lot of variation in quality within every segment of that industry. Perhaps the idea I have picked up is that managed care implies managed costs which implies fewer options and opportunities to obtain better than common-denominator results. Just the process of maintaining good relationships over many years with good physicians, together with knowing that they are not operating under onerous productivity constraints, and that they care about me and will act accordingly, has helped me maintain a positive attitude, a physically active lifestyle, and willingness to persist in doing my part of the process of staying alive.